Introduction

We all make mistakes when we are young. Do you own a tattoo that you regret and have considered removing it? However, horror stories of horrible blistering, scarring or incomplete removal of tattoos may leave you reconsidering whether you should get a tattoo removal [1]. 

With advances in technology, there has been an uprise in tattoo removal lasers, each claiming to be better than the rest. While certain lasers have been the mainstay in the tattoo removal realm, they may not be the most effective. 

Read on to find out how fractionated beam lasers can do better than conventional lasers in tattoo removal. 

How do conventional tattoo removal lasers work?

Conventional tattoo removal lasers hover over the tattoo while emitting pulses of laser energy which pass through the epidermis (topmost layer) of your skin and are absorbed by the pigments from your tattoo [2]. 

These tattoo pigments are broken up into smaller particles, which can then be metabolised or excreted from your body, causing the tattoo to fade.

Conventionally, there are 2 types of lasers that can help with tattoo removal – the quality-switch (Q-Switched) nanosecond lasers and the newer quality-switch (Q-switched) picosecond lasers. 

QS Nanosecond lasers

The Q-Switched nanosecond (QSNS) lasers have been considered the gold standard for tattoo removal, having achieved great clinical results and safety profile [3]. There are many different types of QSNS lasers used. Common ones include:

• QS ruby (694nm) laser
• QS Nd:YAG (1064nm and 532nm) laser
• QS alexandrite (755nm) laser. 

These three mainly differ in the wavelength of light emitted from the laser and hence, their effectiveness in removing different colour pigments of the tattoo [4]. The QSNS ruby and alexandrite lasers are more effective in clearing darker-coloured tattoos using black and blue ink, while the 532nm QSNS Nd:YAG laser is used to clear red and orange coloured pigments in tattoos. 

Other factors like the degree of blistering after the tattoo removal can also vary between the lasers [5]. For example, the QS Nd:YAG laser results in less blistering than the other two lasers. 

QS Pico lasers

More recently, Q-Switched picosecond lasers (QSPS) have shown to be a more effective and efficient way of tattoo removal. While pulses from QS nanosecond lasers are emitted in intervals of nanoseconds, pulses from QS pico lasers are emitted faster in intervals of picoseconds. 

This results in QS pico lasers having a higher efficacy in tattoo removals and a lower risk of adverse effects arising from the tattoo removal [6]. Studies have also shown that QS pico lasers are more effective in clearing multi-coloured tattoos as compared to QS nanosecond lasers, especially for colours like yellow, green, purple and red [7]. 

Conventional lasers don’t always work

Although conventional lasers are said to be effective in tattoo removal, they do not always work. 

Firstly, multiple sessions are required for significant tattoo removal using conventional lasers. Studies have shown that the clearance rate (how much of a tattoo has been removed) is about 70% after 15 sessions of QS laser treatments [8]. This includes QS picosecond lasers. Even though there are many industry-sponsored studies that show QS picosecond lasers are much better than QS nanosecond lasers, which is why I also bought a QS Picosecond laser, you should note though that not all QS Picosecond lasers are equal – this one has 2 class action lawsuits in the world against them by doctors who claim they were over promised and showed fake marketing material that was photoshopped!

Secondly, for some, minimal effect is observed even after multiple sessions [9]. This may be due to a variety of reasons, such as the colour of the tattoo, the depth of the tattoo and even the doctor’s experience [10]. 

Multiple sessions and minimal effects observed are due to gas expansion from the laser’s reaction with the tattoo pigments. Gas expansion creates ‘bubbles’ in the epidermis and dermis layers of the skin, which scatters the laser light and shields the deeper layers from treatment. As such, insufficient laser energy reaches the tattoo pigments, which makes tattoo removal slow and ineffective [11]. 

Thirdly, scarring can still occur using conventional lasers, especially if the tattoo was placed too deep in your skin. Scarring occurs when tattoo by-products are trapped and lodged under the skin from incomplete removal, or gas expansion from the laser reaction with the tattoo pigments [12]. Scarring can also occur if patients do not follow the aftercare tips carefully or choose an inexperienced doctor. [13] 

Lastly, conventional lasers run the risk of blistering and consequently a longer downtime for the healing process. 

FracTat™️ has the potential to out-perform conventional tattoo removal lasers

Think of fractional pico lasers as an upgrade from conventional lasers used in tattoo removal. The latest development in skin rejuvenation treatments, FracTat™️ is a non-ablative, picosecond laser that uses fractionated beams and can be used for tattoo removal, wrinkles and scar removals. 

As compared to conventional tattoo removal lasers, the use of fractional lasers has shown to be able to:

• Improve the texture of skin by stimulating collagen production in the skin 
• Increase the efficacy of treatment
• Significantly reduce downtime and adverse side effects such as scarring [14].

How does FracTat™️ work?

Fotona’s  FracTat™️  is an ultra-short picosecond laser that emits laser beams that do not cause the skin to heat up — unlike CO₂ or Erbium-YAG laser treatments. 

Instead, this laser focuses the photo-acoustic effects of the picosecond pulse duration into an ultra-tiny zone. This results in an explosive skin reaction, which lifts the skin and results in scars and tattoos to resurface. [12]

FracTat™️ works in 4 simple steps [12], [15]: 

1. Pretreatment priming:
   An ablative fractional laser drills microholes into the skin, enabling steam, gasses and ink particles to escape through the skin easier. 
   
   
2. First treatment with a Picosecond pulse
   A full-beam pico laser is used to penetrate the skin without damaging the top layers. The tattoo pigments absorb the pulses of laser energy and break into smaller pieces before being removed by the body’s lymphatic system.

3. Reduced frosting effect:
   Due to the pretreatment priming, steam, gasses and ink particles can easily escape the skin during the treatment. This reduces gas expansion and ‘bubbles’ from forming, which in turn reduces the frosting effect (white residue that appears on the skin due to bubbles rising during the laser treatment). 

4. Subsequent QS pulses are not blocked from reaching deeper lying pigments
   The pretreatment priming also enables the laser emitted from the QS pulse to be able to reach pigments that are deeper in the skin. This allows for more rapid removal of colour pigments from the skin. 

This technology also helps to stimulate collagen production, which helps to prevent any scarring. 

FracTat™️ can give a 100% clearance rate on tattoo removals in a shorter time

FracTat™️ ensures that there is minimal skin damage, by allowing gases to escape from the microholes, relieving pressure generated during the treatment [9].  Without these microholes, blistering, as seen from the photo above, may occur. 

The microholes allow the laser to reach pigments deeper in the skin layer, which helps to clear all tattoo pigments effectively and completely. This improves the clearance rate of the tattoo in a shorter duration and can also prevent scarring.

The FracTat™️ laser also resurfaces and remodels collagen on the skin to prevent and treat scarring. 

With FracTat™️, the number of tattoo removal sessions can be reduced by more than half, with fewer side effects observed by patients! 

What are the side effects or complications of FracTat™️? 

Most people can tolerate FracTat™️ treatment very well. The downtime is very minimal, with people often going back to their normal activities the next day or even right after the treatment. In fact, the FracTat™️ was invented to MINIMISE side effects and complications of tattoo removal.

However, some side effects may occur after FracTat™️ treatment, depending on every individual’s condition and DOCTOR TECHNIQUE. These include [12]: 

• Excessive scaling, peeling or crusting
• Swelling
• Post-inflammatory pigmentation
• Contact dermatitis
• Acneiform eruptions (pustules or papules that look like acne) 

Not all doctors can work with FracTat™️

You are probably wondering – if the FracTat™️ is as good as it claims, why aren’t more doctors using it? The truth is, while the technology is not extremely new, the machines are extremely expensive.

Furthermore, it takes a lot of experience and skills to handle the machine properly and to deliver the right results. Even the best of machines may result in unwanted side effects in the hands of an inexperienced doctor. The analogy I always use is that of a chef: the same set of kitchen equipment and ingredients will produce vastly different tasting dishes in the hands of a masterchef as compared to a cook of less proficiency. 

How do I choose a clinic for tattoo removal?

Choosing a clinic for tattoo removal is very important, as you would want to ensure that everything goes smoothly and you do not pay more than you are supposed to. 

Here are some factors you can consider before choosing a clinic for a tattoo removal [16]:

• Certification: In Singapore, only licensed clinics and doctors are allowed to carry out tattoo removal procedures. Ensuring that the doctor and clinic is licensed can help make you feel more confident about the tattoo removal process.
• Type of lasers used: Fractional technologies such as FRAP or Fotona SupER Erbium YAG laser can help reduce treatment sessions with minimal skin damage, hence allowing you to remove your tattoos in a much shorter time frame. 
• Single or multiple passes: Multiple passes of laser can lower recovery time and reduce complications [17].
• Professionalism of staff: The ability of the staff to provide comfort to the patient is important to help settle the patient’s nerves and have a pleasant tattoo removal experience.
• Provide a reasonable amount of sessions for tattoo removal: A reasonable guide would be less than 6 treatment sessions for most tattoos. 
• Provide options for faster healing, if requested

What is it like getting a tattoo removal? 

First, numbing cream will be applied to the tattooed area for 30 minutes to minimise any discomfort that you may feel during the tattoo removal process. 

Next, you will be led into a private room for your tattoo removal procedure. The whole procedure will take about 30 minutes to complete. Most of my patients have commented that the pain level is tolerable throughout. 

The doctor will check in with you constantly to ensure that you are comfortable and the pain is still tolerable. To increase comfort levels, a cooling fan may be used.

Once the procedure has ended, you will be given aftercare tips to aid in your recovery. I also use BioHeal treatments to aid recovery and minimise downtime in my own practice. 

Aftercare tips for speedy recovery after FracTat™️

It is important to care for your skin properly after getting a tattoo removal to ensure that infection or unwanted side effects do not occur.

Here are some aftercare tips to help in your recovery after a tattoo removal session [18], [19]:

• Keep the treated area clean and dry.
• Lightly clean the treated area with soap and water, patting it to dry.
• Apply antibiotic ointment on the treated area and keep the area in a bandage for the first three days after the tattoo removal procedure.
• Avoid swimming, baths, pools and hot tubs.
• Avoid picking at any scabs or blisters. 
• Apply a cold compress or soothing ointment to help with itching or pain.
• Avoid taking aspirin. 
• Avoid excessive sun exposure. Apply sunblock with SPF 25 or higher for at least three months after the procedure.
• Avoid vigorous exercise for 24 hours after the procedure. 
• Drink more water.  

Conclusion

With FracTat™️, it brings a new, promising approach to effective tattoo removal. The best part is, with reduced sessions required, it can shorten your treatment time and reduce the cost of your entire tattoo removal procedure. Additionally, FracTat™️ even reduces the risks of any unwanted side effects greatly. 

Do choose your clinic and doctors wisely to ensure that your tattoo removal experience will go smoothly. All the best! 

References:

1. Sullivan, R. (2017). This guy’s tattoos turn into third degree burns. [online] NewsComAu. Available at: https://www.news.com.au/lifestyle/beauty/face-body/tattoo-laser-removal-queensland-man-suffers-serious-burns-after-trying-to-get-his-tattoos-removed/news-story/183200c8ca225d4df1d2f82dc8a40696 [Accessed 8 Apr. 2021].
2. Tattoo Removal: Options and Results. (2019). FDA. [online] Available at: https://www.fda.gov/consumers/consumer-updates/tattoo-removal-options-and-results [Accessed 5 Apr. 2021].
3. Barua, S. (2015). Laser-tissue interaction in tattoo removal by Q-switched lasers. Journal of Cutaneous and Aesthetic Surgery, 8(1), p.5
4. Kent, K. M. & Graber, E. M. (2012) Laser Tattoo Removal: A Review. Dermatologic surgery. [Online] 38 (1), 1–13.
5. Amir, N. (1993). Alexandrite Laser Offers Tattoo Removal without Scarring or Skin Texture Changes. Journal of Clinical Laser Medicine & Surgery, 11(5), pp.263–266.
6. Naga, L. I. et al. (2017) Laser Tattoo Removal: An Update. American journal of clinical dermatology. [Online] 18 (1), 59–65.
7. Reiter, O. et al. (2016) Picosecond lasers for tattoo removal: a systematic review. Lasers in medical science. [Online] 31 (7), 1397–1405.
8. Bencini, P.L., Cazzaniga, S., Tourlaki, A., Galimberti, M.G. and Naldi, L. (2012). Removal of Tattoos by Q-Switched Laser. Archives of Dermatology, 148(12), p.1364.
9. Shah, S. and Aurangabadkar, S. (2015). Newer trends in laser tattoo removal. Journal of Cutaneous and Aesthetic Surgery, 8(1), p.25.
10. Eden Laser Clinic. (n.d.). 6 Reasons Why Tattoo Removal Fails – Laser Tattoo Removal Sydney – Tattoo Removal Guarantee. [online] Available at: https://www.tattooremovalspecialist.com.au/news/6-reasons-why-tattoo-removal-fails/ [Accessed 8 Apr. 2021].
11. Kaminer, M.S., Capelli, C.C., Sadeghpour, M., Ibrahim, O., Honda, L.L. and Robertson, D.W. (2019). Increased Tattoo Fading in a Single Laser Tattoo Removal Session Enabled by a Rapid Acoustic Pulse Device: A Prospective Clinical Trial. Lasers in Surgery and Medicine, 52(1), pp.70–76.
12. Veritas Clinic. (n.d.). FracPico Scar and Tattoo Removal. [online] Available at: https://veritas.com.sg/fracpico-scar-and-tattoo-removal/#1588890470391-c1e20fee-afe6 [Accessed 8 Apr. 2021].
13. Svendsen, M. (2019). What to Do with Scarring After Laser Tattoo Removal? [online] Chronic Ink. Available at: https://www.chronicinktattoo.com/blog/scarring-after-laser-tattoo-removal/ [Accessed 9 Apr. 2021].
14. Preissig, J., Hamilton, K. and Markus, R. (2012). Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface. Seminars in Plastic Surgery, 26(03), pp.109–116.
15. Florijancic, U.F. (2019). Fractat® laser treatment for optimized tattoo removal. [online] Estetic Magazine. Available at: http://en.estetic-magazine.com/fractat-laser-treatment-for-optimized-tattoo-removal/ [Accessed 8 Apr. 2021].
16. Ink Revoke. (2017). How to Choose a Tattoo Removal Clinic. [online] Available at: https://www.inkrevoke.com/how-to-choose-a-tattoo-removal-clinic [Accessed 8 Apr. 2021].
17. Tanzi, E.L. and Alster, T.S. (2003). Single-pass carbon dioxide versus multiple-pass Er:YAG laser skin resurfacing: a comparison of postoperative wound healing and side-effect rates. Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.], [online] 29(1), pp.80–84. Available at: https://pubmed.ncbi.nlm.nih.gov/12534517/ [Accessed 8 Apr. 2021].
18. Tattoo Removal Ink. (n.d.). AFTER-CARE. [online] Available at: https://www.tattooremovalink.org/after-care [Accessed 6 Apr. 2021].
19. Removery. (n.d.). Laser Tattoo Removal Aftercare. [online] Available at: https://removery.com/tattoo-removal/aftercare/ [Accessed 6 Apr. 2021].